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Oncology > Gynae Cancers > Flashcards

Gynae Cancers Flashcards

1
Q

List risk factors for endometrial cancer

A

Age
Obesity
Unopposed estrogen stimulation (HRT, Tamoxifen,
PCOS, nulliparity, infertility)
Atypical endometrial hyperplasia (precursor)

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2
Q

How does endometrial cancer present

A

PMB
Vaginal discharge
Abnormal bleeding (intermenstrual, menorrhagia etc)
Pelvic mass

If local spread:

  • pelvic pain
  • haematuria
  • renal failure
  • bowel symptoms
  • back pain
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3
Q

How do you investigate endometrial cancer

A

Transvaginal ultrasound – thickened endometrium
Hysteroscopy
Pipelle biopsy
EUA and curettings
Staging – CT/MRI pelvis, CXR, FBC, Biochemical profil

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4
Q

What is the most common subtype of malignant endometrial cancer

A

Endometrial carcinoma

There are many many subtypes with adenocarcinoma being the most common (90% of cases)

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5
Q

List benign endometrial tumours

A

Endometrial polyp

Leiomyoma

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6
Q

Which malignant tumours can affect the endometrium

A

Endometrial carcinoma
Sarcoma
Lymphoma
Gestational trophoblastic disease - e.g. molar

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7
Q

How do you treat stage 1 endometrial cancer

A

Total hysterectomy + bilateral salpingooophorectomy

Progesterone treatment if fertility needing spared

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8
Q

How do you treat stage 2 endometrial cancer

A

radical hysterectomy + adjuvant

radiotherapy

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9
Q

How do you treat stage 3 and 4a endometrial cancer

A 
radical radiotherapy (External 
beam and brachytherapy)
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10
Q

How do you treat stage 4b endometrial cancer

A

palliative – chemotherapy/

radiotherapy

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11
Q

Which organ is a risk when treating endometrial cancer with radiotherapy

A

Mainly bowel
Acute side effects include: diarrhea,
abdominal pain, dysuria, urinary frequency

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12
Q

Brachytherapy can be used for endometrial cancer - true or false

A

True

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13
Q

List risk factors for cervical cancer

A 
HPV infection – 16 & 18
Early age at first pregnancy
Multiparity
Multiple sexual partners 
OCP
Smoking
DES exposure
HIV (AIDS defining condition
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14
Q

How does cervical cancer present

A

Intermenstrual/ postmenopausal bleed
Post coital bleed
Persistent vaginal discharge
Dyspareunia

Local spread:

  • Renal failure
  • Pelvic pain
  • Bladder outflow obstruction
  • Rectal bleed
  • Urinary/faecal incontinence (fistula)
  • Lymphoedema
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15
Q

If a smear comes back with dyskaryosis (abnormal cells) what is the next step

A

colposcopy ±

biopsy (LLETZ/cone biopsy)

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16
Q

Mets to the cervix are common - true or false

A

False - very rare

Direct spread from endometrium, bladder, rectum, ovary, vagina is more common

17
Q

Which benign tumours can affect the cervix

A

Endocervical polyp

18
Q

Which malignant tumours can affect the cervix

A 
Squamous (90%)
Adenosquamous
Adenocarcinoma
Undifferentiated
Clear cell
Small cell
Transitional cell
Carcinoid, lymphoma, melanoma, sarcoma
19
Q

How do you treat early stage cervical cancer

A

Surgery (radical hysterectomy/ trachelectomy)

Adjuvant radiotherapy if high risk features

20
Q

How do you treat locally advanced cervical cancer

A 
No role for surgery, as not 
curative
Standard of care –
chemoradiotherapy
Local control depends on 
tumour stage, bulk and 
radiation dose
Brachytherapy if feasible
21
Q

How does ovarian cancer usually present

A

Usually presents late

ascites/ bloating
pelvic mass/ bladder dysfunction
pleural effusion/shortness of breath
incidental finding

22
Q

How do you diagnose ovarian cancer

A

Blood test- CA125
Ultrasound- transvaginal/abdominal
Cytology- pleural fluid/ ascites
Pathology

23
Q

What is the most common type of cancer to affect the ovary

A

90% epithelial cell tumours

Includes serous, mucinous, endometriod and clear cell subtypes

24
Q

List the stages of ovarian cancer

A

I- confined to 1 or both ovaries

II-spread to other pelvic organs eg uterus, fallopian tubes

III- spread beyond the pelvis within the abdomen

IV- spread into other organs eg liver, lungs

25
Q

Which surgeries are often used in the treatment of ovarian cancer

A

Total hysterectomy + bilateral salpingooophorectomy
Omentectomy - if spread to omentum
Optimal debulking

26
Q

Relapse rates for ovarian cancer are high - true or false

A

True

Most with advanced disease recur

27
Q

Which chemo types are commonly used to treat ovarian cancer

A

carboplatin/ paclitaxel

Other options if palliative

28
Q

Which new biological therapies are being used in the treatment of ovarian cancer

A

Bevacuzimab- VEGF (vascular endothelial derived growth factor)

PARP inhibitors- PARP-1 ( DNA single strand break repair enzyme)

Decitabine- methylase inhibitors

Oncology (7 decks)

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